Lateral Pelvic Lymph Node Recurrence 5 Year after Endoscopic Mucosal Resection for Superficial Lower Rectal Cancer

摘要

A 73-year-old woman underwent endoscopic mucosal resection for a 10-mm-diameter rectal polyp (Isp) within 5 cm of the anal verge in November 1995. Pathological examination showed that well-differentiated adenocarcinoma had invaded the submucosal layer with vascular invasion. Although secondary surgical treatment was recommended, the patient refused further treatment. Right-sided sciatica developed in December 2000, and metastasis to the right obturator lymph node was detected with computed tomography. Intrapelvic lymphadenectomy was performed in February 2001 and revealed no other metastatic lesions. Total mesorectal excision (TME) should be performed if another surgical procedure is to follow endoscopic mucosal resection. Because lateral pelvic lymph nodes are not dissected at TME, the procedure had no additional benefit for our patient. The secondary surgical treatment for early cancer in the lower rectum should selected carefully.